Provider Alert! COVID-19 Vaccine Administration Procedure Code 0073A is now a Benefit
Date: February 9 , 2022
Attention: All Providers
Effective date: January 3, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Effective for dates of service on or after January 3, 2022, COVID-19 vaccine administration code 0073A is a benefit of Medicaid and CHIP for the administration of the third (additional) dose of the Pfizer-BioNTech COVID-19 vaccine for children 5 through 11 years of age.
The U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to include a third dose for certain immunocompromised children 5 through 11 years of age, administered at least 28 days after completion of the primary series.
As a reminder, vaccine procedure code 91307 is informational only while the vaccine is distributed to providers free of charge.
How this impacts providers: Procedure code 0073A is a benefit for the following providers and places of service:
| Place of Service | Provider Type |
| Office | Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Federally Qualified Healthcare Centers (FQHC), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHC), Pharmacy, Comprehensive Care Program (CCP) Provider |
| Home | PA, NP, CNS, Physician, Home Health Agency, CCP Provider |
| Outpatient Hospitals | FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs |
| Other Locations | PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs |
Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0073A for individuals 5 through 11 years of age, as of January 3, 2022.
Providers may bill MCOs retroactively for COVID-19 vaccine administration code 0073A provided on or after January 3, 2022, for individuals 5 through 11 years of age. TCHP must reprocess affected claims submitted with the procedure code and date of service on or after January 3, 2022. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
Next steps for providers: Providers should share this communication with their staff.
Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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